Health Services Research
The cancer program includes investigators focused on health services research in a number of key domains including decision-making, quality of life, quality improvement, practice guidelines, and coordination of care. Active collaboration exists across this research agenda and current investigators are affiliated with a range of disciplines, university schools and departments.
The Supportive Cancer Care Research Unit (SCCRU)
The SCCRU, led by Dr. Tim Whelan and Dr. Jonathan Sussman, has been conducting seminal research into health services and cancer since 1991. The Unit was established as a health systems-linked research unit and is supported by the Ministry of Health and Long-Term Care and Cancer Care Ontario. Unit Director, Dr. Tim Whelan holds a Canada Research Chair. The unit consists of a multidisciplinary group of investigators including oncologists, family physicians, health services researchers, biostatisticians, a medical sociologist and a health economist. Researchers affiliated with the Supportive Cancer Care Research Unit include Kevin Brazil, Director, St. Joseph's Health Research Network; Peter Ellis, Medical Oncologist with an interest in shared decision-making; Cathy Charles, a medical sociologist who focuses on conceptual models of shared decision-making; and Amiram Gafni, a health economist whose research interests lie in the area of economic evaluation of health care programs. Over the last 14 years, the SCCR unit has been engaged in a large number of groundbreaking research projects; many of these have been supported by national and international research agencies. Unit research has been presented at numerous international conferences and published extensively in widely read cancer journals.
Some of the key studies have had major impacts on communication and decision making in patients with cancer, improving efficiencies in the cancer system and increasing coordination of cancer services and patient quality of life.
As with all experienced research units, priorities and foci of research shift over time. Originally, as per the goal of health systems-linked research units within Ontario, the SCCRU responded to needs identified by partners, in particular the JCC. More recently, the unit has responded to direct contract requests from the Ministry of Health and Long Term Care. The unit has adopted a conceptual model for health services research called the Needs Service Path. Along the path from a recognized need (patient or health system perspective) to an ideal service, there are certain steps or questions: e.g., is the need recognized, are services sought, are services available, are services effective, and are services efficient? Using such a model, the SCCR unit research focuses on identifying need, developing interventions, and evaluating the effectiveness of these interventions or health services within the cancer system. The research conducted by the SCCRU has extensively explored needs and gaps in various cancer service areas. Once these are identified, this focus then shifts to a rigorous study of the impact of various models on the overall system of care and the cancer patient. The unit's research initiatives have evolved over time from initial exploratory or 'discovery' research to impact and evaluation analysis. The goals of the latter are to provide decision-makers in the health care system with concrete recommendations for system improvements in the area of coordination of services, patient support, and cost effectiveness. The perspective taken is always that of working to improve the lives of those patients living with cancer and their families, through sound evidence based research focusing on care delivery, coordination, practice guideline development and clinical treatment.
System-Wide Quality Improvements in Surgical Oncology
Cancer surgical health services research, with lead investigators Drs. Marko Simunovic and Laurie Elit, has focused on understanding access to care issues and the effectiveness of care. Utilizing large administrative databases in Ontario, Dr. Simunovic and colleagues have evaluated the relation between the volume of pancreatic and rectal cancer surgery and perioperative mortality. In the case of the former cancer, a three-fold difference in outcomes provides a strong rationale for the concentration of pancreatic cancer surgery in a few high volume centres. Dr. Simunovic received CIHR funding to undertake a quality initiative related to rectal cancer surgery in which a strategy is being tested to determine if surgical outcomes can be improved. Specifically, the strategy involves training surgeons in a new rectal cancer surgical technique in order to reduce the rate of permanent colostomy and reduce local recurrence. His work is focusing on knowledge translation and improving the quality of surgical care in the local LHIN.
Dr. Elit has conducted research to improve the quality of care for gynecologic malignancies, particularly ovarian cancer. She has received funding from NCIC to examine the surgical practice in Ontario for ovarian cancer and to determine the factors that determine best practice. She has conducted qualitative research on how women with ovarian cancer feel about the care they have received. She has led a multicentre international trial funded by CIHR that examines the best way to manage CIN1, a premalignant condition of the cervix and the relationship between this condition and the HPV virus.
A Centre of Excellence in Oncology Advanced Practice Nursing (APN)
While Canada has one of the best cancer control systems in the world, there is no doubt the health care system has a huge challenge related to the rapidly increasing number of people affected by the disease. By 2020, the incidence of cancer in Canada will rise by 70 per cent and the current approach to cancer control funding will not be able to meet the rising demand for care.
The JCC has been on the forefront of supporting and implementing APN roles to help advance care for patients at the Centre. Recognizing the need for expanding the contribution of APNs, the JCC and McMaster University School of Nursing recruited Denise Bryant-Lukosius, PhD, APN in 2006, to lead the development of an integrated program focusing on excellence in long-term, leading-edge initiatives in oncology APN research and education. Her current work, funded by the Change Foundation, aims to improve the use of oncology APN roles by developing and evaluating tools to support role implementation; applying systematic frameworks; and using collaborative strategies to engage stakeholders in APN role development and evaluation. The JCC and Sudbury Regional Cancer Centre are pilot sites for this work. The project aligns with two of the Ontario government's policy priorities to provide better health care services to remote communities and those suffering from cancer.
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